From the Guidelines
The most common cause of palpitations in adolescents is sinus tachycardia, which is a normal physiological response to exercise, anxiety, stress, caffeine consumption, or other stimulants. This condition represents a normal heart rhythm that is simply faster than usual, typically exceeding 100 beats per minute. Other common causes include premature atrial contractions (PACs) and premature ventricular contractions (PVCs), which are generally benign in adolescents with structurally normal hearts, as noted in the guidelines for the management of patients with supraventricular arrhythmias 1. Anxiety disorders are particularly prevalent in this age group and frequently manifest with palpitations as a physical symptom.
Key Considerations
- Most adolescents experiencing palpitations do not require medication, but management focuses on lifestyle modifications such as reducing caffeine intake, ensuring adequate sleep, managing stress, and avoiding stimulants.
- The clinical history and physical examination are crucial in determining the cause of palpitations, including distinguishing between regular and irregular palpitations, and identifying potential triggers or associated symptoms like dizziness, fainting, or chest pain.
- While most cases are benign, persistent or concerning palpitations should be evaluated by a healthcare provider to rule out less common but more serious causes such as supraventricular tachycardia, Wolff-Parkinson-White syndrome, or structural heart abnormalities, as emphasized in the guidelines 1.
Management Approach
- Lifestyle modifications are the first line of management for benign palpitations in adolescents, aiming to reduce symptoms and improve quality of life.
- Further evaluation, including electrocardiogram (ECG) and potentially other diagnostic tests, may be necessary for adolescents presenting with concerning symptoms or those whose palpitations do not respond to initial management strategies, as suggested by the clinical guidelines 1.
From the Research
Causes of Palpitations in Adolescents
- The most common cause of palpitations in adolescents can be attributed to cardiac awareness or a fast/irregular cardiac rhythm 2.
- Premature ventricular contractions (PVCs) are relatively common and can cause palpitations, but are often considered benign 3, 4.
- PVCs can be a sign of underlying cardiac disease, but many patients with PVCs only need reassurance and do not require a cardiologist referral 4.
Evaluation and Diagnosis
- Patients with abnormal ECG, non-sinus tachycardia, abnormal cardiac examination, concerning family history, or palpitations associated with activity or syncope should be referred to a pediatric cardiologist 2.
- Establishing symptom-rhythm correlations is essential to determine the appropriate treatment for patients with frequent PVCs 5.